Cutaneous Warts Flashcards
Define
Condylomata acuminate -> caused by HPV infection – HPV 6 and 11 (remember, it’s the SMALL numbers)
- Most are sexually transmitted (10% prevalence in the sexually active population)
- Prevention – HPV vaccine ‘Gardasil’ – protects against subtypes 6, 11, 16, 18
- 6, 11 à 90% of cutaneous warts
- 16, 18 à over 70% of cervical cancers
Benign epithelial tumours - one of the most common conditions treated in GUM despite the vaccine
Inc oral sex
- Happens relatively soon in a sexual relationship
- No evidence that treatment affects transmission
- Perinatal transmission is also possible
- Important to remember within 1 wart you may have different combos of subtypes, e.g., you can have just 6 or 6 and 11 or 6 and 16, etc.
- Viral gets through microabrasions in the skin and gets to the basal layer, but most replication occurs in the stratum spinosum –> viral gets released from the stratum corneum
Signs and symptoms
Often asymptomatic
- Vaginal discharge, PCB or IMB (local trauma), pain
- Genital warts on vulva, vagina, cervix, anus à generally painless but may itch or bleed or become inflamed
- Extra-genital lesions are rare but can find them on the oral cavity, larynx, conjunctivae and nasal cavity
- HPV is common in pregnancy
- Warts may rapidly enlarge with pronounced vascularity with advancing gestations and can obstruct labour or bleed during delivery
- Regression of warts follows quite quickly postpartum
- C-section is not recommended
Investigations
(often a clinical diagnosis):
- Diagnosis on visual inspection
- External genitalia examined - speculum exam
- Sometimes a biopsy may be required esp if lesion looks unusual
- STI screen à triple swab, HIV, syphilis, HBV
Management
Incubation period is variable, but normally within 2 years
- Higher VL is linked with infectivity, persistance and recurrence
Often, no treatment required; might refer to GUM if STI risk factors
Medical (contraindicated in pregnancy):
- Keratinised warts à imiquimod cream
- Non-keratinised warts à podophyllin/tri-chloro-acetic acid
Surgical – cryotherapy, laser, electrocautery
Complications
May be high-risk HPV leading to increased risk of anogenital cancers
Disfiguring – distress or psychosexual dysfunction
Genital warts PACES advice
Clinical wart disease does not usually cause cancer
Female patients do not need more frequent cervical cytology if they have genital warts
Contact docs early if they develop future lesions or anal bleeding
HPV vaccines (Gardasil) - 2 doses for children
Since 2018 also given to MSM up to age of 45yo
